The project is designed to describe and understand the system and the process of program change which was stimulated and implemented through the Federally supported Hospital Improvement Program (HIP). A time frame from 1964 through 1972 is employed to assess the character of the response of state hospitals to the opportunity to subscribe to the program. Subscription is then related to hospital factors and social- living conditions in communities in which state hospitals are located. The process of change in hospitals which subscribed to HIP is then studied with respect to different classes of change programs, with respect to previous organizational experience with change, with respect to various forms of change planning, change implementation and change results, and with regard to the capacity of change agents to tolerate modification in their change plans.